Life (and death)...

My life as a Malaysian doctor in the United States.

Friday, May 31, 2013

Admittedly, I'm getting hooked. I forgot how I loved looking at the celestial bodies, and just how fascinating this can be. But in the last couple of weeks I've found myself wishing for good weather, just so I can sneak out with the telescope to stargaze and snap some pictures.

And I have to say that for a beginner, I'm quite proud of these pictures. This was the moon, taken a few days ago.

And presto, this was the planet Saturn! It was a lucky 2nd attempt, using the DSLR as a webcam and then using astrophotographic software to stack things.﻿

Something tells me this hobby is going to end up being very time-consuming!

Tuesday, May 28, 2013

Difficult Patients

Sometimes, you just can't please everyone. And I had to deal with a yelling patient today.

It was an unusual Tuesday, but perhaps being the first day back after a long weekend, things got busier than most. I had to work in a patient over lunchtime. And another urgent request because she was pregnant and her diabetes was uncontrolled.

To top that up, I had a patient come 20 mins later (which really meant he was 35 mins since patients are asked to come in 15 mins early for our medical staff to reconciliate their medications and get the labs started). Clinic policy is that 15 mins or later we may ask for them to reschedule- something I try not to do but today was an exception. There was no way I was going to be able to catch up, and to make other patients who came timely wait because this person came late, didn't seem fair. So I suggested he reschedules with me at a future date, or see my nurse practitioner today, or wait until there was a cancellation on my schedule.

I was then told by the receptionist that this patient got mad. Really mad; was hollering and yelling and ripped up his papers before he stomped out. A few hours later when I had some downtime, I called to check up on him and to try to appease him.

Big mistake. I got an earful, from how I was "playing God", and how he was "only 10 minutes late" (really 35) and how he was offended that he was asked to see the nurse practitioner because they don't "know anything" (untrue- midlevel providers are highly trained and are able to work autonomously without physician supervision). He used some choice language and made numerous accusations. And when I asked how we could help work things out, he said he wasn't coming back.

It was unfortunate this happened. And my staff and I were as courteous as we could be. And knowing how busy the day was and how urgent some of the other patients were, there wasn't anything I would have done differently. That being said, it doesn't make the day any less unpleasant and needless to say, this one interaction spoilt the rest of my day.

I suppose such is life; there are some you can help, and there are some you can't.

Thursday, May 23, 2013

Moonshot

I took this picture using the telescope last night. I have to say, I forgot how addicting stargazing and astronomy is. I've been taking the telescope out 2-3 times a week these days. And though I got the lower end 1300 mm 4" Nexstar SE, I've seen some breathtaking views of the moon, Jupiter and Saturn.

What's most surprising was the above picture was taken with my iPhone- I basically pointed the camera into the eyepiece and snapped a picture.

Tuesday, May 21, 2013

Dr. Patient

Sometimes you never know where your patients may be coming from.

I saw H last week for the first time; he was a 50+ year old Middle Eastern man with type 2 diabetes. He worked as a pharmacy technician, so I wasn't surprised when we used some medical terminology at our meeting.

But I was impressed by his level of knowledge of pancreatic physiology, and prodded him a bit further. Turns out he was a cardiothoracic surgeon in his home country. But because his credentials were not recognized here, he needed to go back to medical school and residency before he could practice as a surgeon. At this age, he didn't think he had the stamina to do so, and so humbly worked in the pharmacy dispensing meds instead.

Reminds me of a cab driver I met while in medical school in Canada; he practiced as a neurosurgeon in Russia before his emigration.

And though he missed practicing surgery, he was happier with his new life there.

But it did get me thinking that it was a shame, not being able to use their talents just because of some bureaucratic red tape.

Saturday, May 18, 2013

2 years

Hey buddy.

It's been two years since you left our world for the next. I imagine you've probably been watching over us and you know, much has changed.

We have another child now. She turns 9 months today; and yes, you're probably laughing over how I'm outnumbered by the females. Even the other male in this household- the damn dog has been castrated. And so I'm the only one producing significant amounts of testosterone (yes, you know females make this stuff too, but in minute amounts). And so, it's ironic that your roomate of 5 years who was always complaining of the lack of women in his life during those pathetic years, is now surrounded by them.

The world seems to be a different place now too. Or perhaps it's just me- I've learnt to see things with jaded, saddened eyes. The recent elections in Malaysia. Even the ongoings here and the senseless gun violence, with people on both sides of the gun-control fence yelling at each other. You've probably met the little angels from Sandy Hook. And you probably shed some tears too by the recent Boston Marathon bombing. Why? Why waste these lives, when others who tried to fight their illness so hard, had to lose? Why does Man commit evil towards his Brother?

I can't believe how the last two years just flew by. It doesn't seem like that long ago when Kris and I got married, and you gave your Best Man's speech. Or when you got married; Nat King Cole's L-O-V-E still reminds me of your first dance- for a 'kayu' person you performed pretty well! I remember well that last night we met, when we had dinner at that food court in Penang. You were pretty nonchalant about it and pretended you didn't see the tears streaming down Kristin's and my cheeks. We knew that would be the last time we'd meet in this world- being the oncologist I'm sure you did, too. But I sure appreciated how you gave us that last chance to fly back and see you- I heard your condition worsened shortly after we (and Chairman) left. I'm not sure if the science backs this up, but perhaps you know if it's true- the dying sometimes have control over when they are ready to go. And perhaps it's presumptive of me, but it's heartwarming to think that you held out for us to see you one last time and to bid you goodbye. And Alli was under a year old, I tell her about you occasionally, and I'll make sure she remembers you.

And oh, did I tell you I met the family of one of your peers? He had metastatic esophageal cancer too, except he was much older, and was bitter of his diagnosis and couldn't accept things. Until he met you and was so inspired by your attitude and your peace. He passed away after you did, but I met his wife and daughter here in a strange twist. And we shared some tears talking about you and him.

We're settled in here pretty well. Perhaps too well; years ago I wouldn't have imagined myself in the midwest. Midsized city, in private practice. I always thought I'd be back in Malaysia. Or at least in some major academic institution like our Mothership. But sometimes fate leads you to unexpected places. Work is OK, I tell myself. There are things I wish was different- I miss the mental stimulation of being at the Mothership, of being involved in scholarly activities. I would have liked to have more involvement in the teaching of residents and fellows. But it's OK; I'm not complaining- I am a partner in my group, and I have some good colleagues. Though I wish I was less involved in the business aspects of things. I'm a doctor, a healer. I'm not an accountant, or a businessman, or a disciplinarian.

I miss our chats. As nonchalant or casual as we sometimes make it to be, I miss them. There aren't many I get to share my thoughts and fears and frustrations to. As a father and head of household, sometimes you have to keep a lot in. I miss our last-minute buffet meals at which we bitch and complain about the world. As minor and unimportant as those may be, it was therapeutic.

And needless to say, I miss my Halo wingman. You might have been proud of me when I finally completed Halo 4. Damn game took me a long time, and I was stuck many times on many levels. I still have your player profile on my Xbox, and I was saddened to see your name there when I logged in to play alone. And heaven knows my wife isn't a help; she'd probably end up killing us accidentally by dropping a grenade on us! And so, I played alone. Woke up at 6AM on weekends before the kids got up to play. And after 2 months, I completed it! Maybe someday I'll teach Alli how to play and be my new wingman.

Anyway, I know how you hate sentimental words. Didn't mean to embarrass you. Just that I wanted you to know that though you passed away 2 years ago, we haven't thought of you less. And know I look forward to seeing you again, I know it will be awhile. But do look over us in the meantime.

By the way, I found this old picture. This was our first ACP meeting. We looked so young back then, didn't we? Gawd.

Monday, May 13, 2013

Holy Shit!!

When I saw him 3 months ago and did nothing to adjust his insulin program, he wasn't impressed. He wasn't happy that I instead suggested he spends some quality time with my diabetes educator.

"Why can't you just tell me what dose of insulin to use?"

Because things change. Diet and meals. Activity levels. On a daily basis. So rather than making a change for him, it's often best to provide a person the knowledge and tools of carbohydrate counting, and insulin adjustment principles. It was clear Mr. D would benefit from it as he had little insight on how to adjust.

And so when I saw him the other day and handed him his bloodtest result, and it showed his hemoglobin A1c to be 6.4%, that was his reaction. From a previous 13.3%.

As they say, give a man a fish and he will eat for a meal. Teach a man to fish and he will eat for a lifetime.

Friday, May 10, 2013

Happy Nurses' Week!

Because I could never listen to a patient, to comfort one, to hold his hand when he's afraid, to change his clothes when he is diry, to cry a few tears when she passes away, to protect her and be her advocate when she isn't able to take care of herself, or do countless other tasks, as well as a nurse can.

Happy Nurses' Week!

This was the pancake crew of doctors working the 630AM shift, serving breakfast to our nurses!

Wednesday, May 08, 2013

The aftermath

If you're Malaysian, you're well aware of the outcomes of the elections. Thousands of miles away, we followed the updates online.

Naturally, I was disappointed. Disappointed that the outcomes were not different. But even more disappointed by the tactics some parties used to 'win'. If these allegations are true (admittedly social media is not always correct there appears to be video and photographic evidence)- in simple terms, they cheated.

I'm heartbroken as many of you are. Saddened and in mourning over what seems to be the lack of democracy and fairness.

And outraged by the seemingly arrogant and irresponsible remarks the man who is supposed to be the political leader and representative of all Malaysians, suggesting or accusing a certain race for the outcomes of the elections.

With even the PM stoking the fire, what future is there for the minorities in Malaysia? Who will protect their interests? And does anyone still look beyond skin color? I am fearful.

But, if there is a silver lining in all this, it was heartwarming and encouraging to see how most, regardless of skin color, was united in this cause. How, despite the reports of threats and violence, good people helped each other out.

Yes, I'm heartbroken; I still am. But this will heal, as I'm sure yours will. And perhaps someday, there will be enough who will say no to greedy, racist and corrupt leaders.

Saturday, May 04, 2013

The day of reckoning

I left Malaysian in 1998. Have since spent over a decade between Canada and the USA. But the saying that you can take the boy out of Malaysia, but you can never take the Malaysian out of the boy, hasn't been truer than today.

It's Sunday in Malaysia. Thousands of miles away, I am glued to social media sites, reading updates every minute. I am pacing the floor, anxious. I am outraged reading about the ploys and the tricks some resort to. And when dad sent me a picture of his finger after he voted; the amazingly undefeatable indelible (invisible) ink:

Malaysia, though we are far away, many of us still proudly call ourselves Malaysian, and wish the best for you. I pray for a peaceful elections, and that the party and its selfish goals that has been poisoning the nation and dividing her people will finally be toppled. I hope to wake to up good news tomorrow morning.﻿

Friday, May 03, 2013

Historic GE-13

Whatever the outcomes this weekend, the 13th Malaysian General Elections will be a historic event.

For far too long, Malaysians have put up with a ruling government that emphasizes cronyism, corruption, racism and personal gain.

For far too long, powers-that-be have held on to that power, and signs indicate that the powers-that-be are fearful of losing that grip on the Malaysian people.

I tell my patients you can't believe everything you read on the internet. But with social media and all you read about, you can't help be worry and be disheartened about the desperate moves the ruling party appears to be resorting to.

Open vote-buying, bribery. Subtle threats of racial violence, or playing the racial card to divide and conquer. Phantom voters, even to the extent to apparently flying in foreigners to vote for them.

Whatever the outcomes, this will be a historic event, reminiscent of the Arab Spring movement. If nothing else, this highlights the power of the internet and the social media. The corrupt leaders and their illegal or unethical practices are no longer hidden. Someone, somewhere is watching, and if they see a wrong, somehow it will be exposed. Perhaps it might be too slow and too few to affect the outcome of this election (though many of us wait with anxious and open hearts that the ruling party will finally be toppled), eventually the movement will gain enough momentum.

If not this time, perhaps the next. But, oh, please let it me this time.

Ini kali-lah, Malaysia. Vote wisely; the rest of us who are abroad hope for the best.﻿

About Me

A Malaysian endocrinologist, trained in a major academic center in USA, and now surviving in the world of practice after 12 years of training.
To maintain patient confidentiality, names, ages and genders have been altered (And some stories totally fabricated to fool gullible readers).
This site is not meant to provide medical advice or consultation.